Request An Appointment

Please use the form below to request an appointment with Mwaiwathu Private Hospital. This form will be sent to a registrar at our facility who will call you back within one business day to confirm a date and time with you. Our Registrars receive Internet inquiries and will place phone calls between 8:30 a.m. and 5 p.m., Monday through Friday.

Mwaiwathu Private Hospital considers the information you provide as confidential and it will not be shared with any third parties.

All submissions will receive an automatic e-mail informing you that we have received your information.

If you would prefer to make an appointment by telephone, please call us at (265) 01 822 999/ (265) 01 822 538/ (265) 01 834989Note: This form is not for people who need urgent medical care. For medical emergencies go immediately to the nearest emergency room.

Thank you for choosing Mwaiwathu Private Hospital.

Patient Information

Name:

Gender:

Date Of Birth:

Address:

Email:

Primary Phone Number:

Secondary Phone Number:

I am the

Patient Type:

Reason for visit:

Contact Information

Same as patient information

Name:

Telephone:

Please indicate the day and time you would like to schedule your appointment. This
information will expedite the process when our Registrar calls you.

Preferred Day and Approximate Time for Appointment (We will identify a specific
time when we call you.):

How soon?

First Choice:

Approximate Time

Second Choice:

Approximate Time

Thank you for completing the form. To proceeed click on Submit to send the information or click on cancel if you do not want to send the information.